title: Successful single-session endosonography-based endoscopic retrograde cholangiopancreatography without fluoroscopy in pregnant patients with suspected choledocholithiasis: a case series.
abstract: OBJECTIVE
  Same session endosonography (EUS) immediately prior to scheduled endoscopic retrograde cholangiopancreatography (ERCP) may eliminate the need for ERCP and its associated risks in pregnant patients with no evidence of choledocholithiasis on EUS. In patients with choledocholithiasis, EUS provides information regarding the location, size and number of stones present, which helps guide biliary interventions and confirm stone clearance without the use of fluoroscopy.
  
  
  METHODS
  We retrospectively identified 10 pregnant patients referred to our tertiary endoscopy center for suspected choledocholithiasis between June 2008 and January 2012. All patients underwent same-session EUS-based ERCP.
  
  
  RESULTS
  Of 10 pregnant patients managed with EUS-guided ERCP, six were found to have common bile duct stones and went on to ERCP. Four patients with no evidence of choledocholithiasis on EUS did not undergo ERCP. Patients with confirmed choledocholithiasis underwent ERCP without the use of fluoroscopy using the additional information provided by EUS.
  
  
  CONCLUSIONS
  Same-session EUS immediately prior to scheduled ERCP may eliminate the need for ERCP and its risks in pregnant patients with no evidence of choledocholithiasis on EUS. In patients with confirmed choledocholithiasis, EUS provided additional information regarding the location, number and size of bile duct stones, which enabled the successful clearance of the bile duct without the use of fluoroscopy.
authors.affiliation: Paul May and Frank Stein Interventional Endoscopy Center, California Pacific Medical Center, San Francisco, California, USA.
authors.forename: Sheba
authors.initials: S
authors.lastname: Vohra
authors.forename: Edward W
authors.initials: EW
authors.lastname: Holt
authors.forename: Yasser M
authors.initials: YM
authors.lastname: Bhat
authors.forename: Steve
authors.initials: S
authors.lastname: Kane
authors.forename: Janak N
authors.initials: JN
authors.lastname: Shah
authors.forename: Kenneth F
authors.initials: KF
authors.lastname: Binmoeller
mesh_terms: D000328:Adult; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D042883:Choledocholithiasis / Q000000981:diagnostic imaging*; D002769:Cholelithiasis / Q000000981:diagnostic imaging*; D019160:Endosonography; D005260:Female; D042882:Gallstones / Q000000981:diagnostic imaging; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000000981:diagnostic imaging*; D012189:Retrospective Studies
keywords: Choledocholithiasis; Endoscopic retrograde cholangiopancreatography; Endosonography; Fluoroscopy; Pregnancy